Action research in mental health: acute care teams

Action research applies knowledge and research findings to practical problems in order to strengthen the capability of the work unit, to contribute to the personal growth and satisfaction of organization members, and to improve theory. An action research project studying acute care teams at a state residential psychiatric facility found that foreign-born physicians chair high-performing teams. This unexpected result strengthens theories of diversity, status inconsistency, and project team effectiveness.     

Competition and health care policy: experience and expectations

Since 1970 federal policymakers have tried to strengthen competition and incentive-based market forces as alternatives to regulation in containing health costs. The effort to stimulate the growth of health maintenance organizations (HMOs) throughout the country has had limited results, and federal plans to promote competition by enacting changes in the health insurance market have so far come to little. Coalitions in some localities have shown growing interest in flexible HMO variants, however, and the intellectual force of the HMO critique of mainstream practices remains strong. Moreover, the federal government has shown new interest in prospective reimbursement of hospitals--a proposal that draws from both HMOs--competition--and hospital rate-setting programs--regulation--the element of prospectivity.     

Developments in health care finance

Costs, quality, and access are the central themes in health care policy in the United States. In the 1980s the predominate issue is becoming access, and the likelihood for universal health coverage, or a national health insurance program, is growing. This paper explores how the America health care system got to this point and examines the present conditions, the trends, and the consequences of those trends.     

Medical alert: sexual harassment in the health care industry

Sexual harassment is an illegal form of sexual discrimination prohibited by Title VII of the Civil Rights Act of 1964. Although the U. S. Supreme Court has recognized that sexual harassment is illegal conduct for which an employer is liable, this transgression continues to be a major workplace problem. Although some researchers have analyzed the incident level of sexual harassment in general, little work has been conducted on particular industries.

The research described in this article is the summary of the results of a study of sexual harassment in the health care industry. A written survey was sent to 950 randomly selected members of the Kentucky Board of Nursing. Thirty-five percent of the 441 respondents to the survey indicated they had been sexually harassed in their capacity as nurses. More than 77 percent of those occurrences involved physicians as the harassers. When harassed, 51 percent of the respondents were aged 25 to 35; 25 percent, 25 or younger; 20 percent, 36 to 45; and 4 percent were 46 to 55. Fifty-three percent said they were harassed by supervisors; 32 percent said they were harassed by patients.

The survey showed that 23 percent of those harassed felt threatened in their job status if they did not go along with harassing behavior, and 24 percent reported the incidents. Only 23 percent of the nurses indicated that their employers had policies and procedures in place to address sexual harassment. Further, of the respondents that reported being sexually harassed, only 23 percent of these victims reported the incidents.

Sexual harassment complaints in the health care industry must be taken seriously. Health care institutions must adopt appropriate policies and procedures to address sexual harassment. The written policy statement on sexual harassment should show strong support from top management, specify the types of behavior perceived as sexual harassment, and be widely disseminated. Training should be provided to all staff, and effective enforcement mechanisms should be implemented.     

Reforming United Kingdom's health care system

The paper's focus is on the notably pragmatic style and processes of reform in the UK. Selected key themes illustrate aspects of this. They comprise: the separation of purchaser-provider responsibilities and the development of an internal market in health care. Many of the changes now being introduced were not part of the original proposals put forward in 1989. They emerged in response to Ministers' wishes or preferences as they became caught up in implementation and were held accountable for its achievement. In assessing the NHS reforms, a major problem has been the lack of sound, independent research to evaluate their impact. The limited, though growing, research that has been conducted suffers from being unable to distinguish causality from association. Few reliable conclusions about the impact of the reforms can be drawn from research. It remains virtually impossible at this time to draw up a definitive, overall balance sheet. A number of political lessons are identified. If the preconditions prevailing in the UK in late 1988 and early 1989 were to exist elsewhere then reforms similar to those in the UK may be forthcoming. It is important, however, not to overlook the particular factors evident in any country which will ultimately determine the nature of health care reforms and their outcome.     

Reforming New Zealand's health care system

In common with many OECD countries, New Zealand has been engaged in a process of reforming the nation's health care system. In New Zealand's case the reforms have been particularly far reaching and effected within a remarkably short time frame. In 1991 the policy framework was made public, and the legislation to underpin the changes enacted in 1993. Shadow bureaucracies anticipating the reforms were set up as early as 1991, however, thus allowing for the changes to be effected in advance of legislation. Thus in the space of a few years, the social security model of health care, which had been in place for over half a century, was transformed into a system characterised by managed competition. This article begins by briefly describing the social security model of health care, and its inherent problems. I go on to analyze the reforms, focusing on the problems of the previous system that the reforms were intended to address. The major planks of the new system are identified, namely the separation of purchasing of health services from provision and creating a competitive market; the distinction between “personal” and “population” health services; establishment of a core of services to which all citizens are entitled; and the integration and capping of funding for health services, and increasing cost-sharing. Of these policies, only the separation of purchasing and provision of health care and the integration of funding for health services have to date been fully implemented, the remainder having been delayed, modified or abandoned. The health care system has arguably been only partially reformed, therefore.     

Reforming united states' health care system

The US health care system, characterized by high costs and limited health benefits coverage, is constantly undergoing reform. This paper presents a brief overview of the US health care system and its current reform: the use of managed care and medical savings account plans; reducing Medicare and Medicaid spending; and the regulation of managed care system.     

Band-aids to patch up health care

The President and his Democratic rivals unfurl plans for curing the crisis. But all of them have drawbacks, and none is likely to be adopted in the fury of an election year.     

Multilateral health care negotiations: the shadow at the bargaining table

Third-party payers and state regulatory agencies play a major role in health care negotiations. Third-party payer impact arises because of the significant amount of revenue provided to health institutions by these revenue sources. This article reviews the process by which third-party payers and state regulatory agencies affect health care negotiations and the outcomes experienced under these arrangements. The author describes the multilaterial bargaining structure of health care negotiations and illustrates this relationship through recent hospital bargaining in New York City.     

Incomplete vertical integration in the health care industry: pseudomarkets and pseudopolicies

Most economic relationships are either arm's-length exchange transactions, each party seeking his or her own interest, or command structures, such as a firm or public agency, integrating joint efforts toward a common goal. The health care industry, however, displays a pattern of incomplete vertical integration--relationships which are neither truly arm's-length nor completely hierarchical. The doctor-patient relationship is archetypical. Physicians appear to sell services in private markets; yet they reach through the exchange process to direct the consumer-patient's utilization decisions, implicity undertaking to act in the patient's interest, and thus integrate forward. But they also integrate backward to control the public regulatory process--self-government--and some forms of insurance. The health care systems of different countries--Canada, the United Kingdom, and the United States--can be interpreted as different patterns of incomplete integration among five basic classes of transactors: consumer-patients, first-line providers, second-line providers, insurers, and governments. Each system of linkage has characteristic strengths and weaknesses. Nowhere, however, do we find a predominance of arm's-length market relationships. Where they exist, markets in health care are usually pseudomarkets dominated by one side of the transaction. The rhetoric of market relationships serves principally to obscure political struggles over shifting patterns of integration.